Is Facility Fee Charge Waived for Medicare When Using Modifier -33: Q&A With Rosalind Richmond of GENASCIS

Rosalind Richmond, CCS, is chief coding and compliance officer for GENASCIS.

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Q: In the use of modifier -33, it appears to me that all copays and deductibles associated with preventive A services (e.g., colorectal screening colonoscopy) including associated facility fees would be waived for patients with group health plans seeing in-network providers. The Medicare provision as outlined in the 2011 final fee schedule appears to waive only the deductible of the professional fees in the range of the surgical CPT codes and does NOT appear to include the associated facility fees. Can you confirm that the facility charge is not waived for Medicare?

Rosalind Richmond: Medicare does not recognize modifier -33 for colorectal screening; this modifier is used for commercial payors. Modifier -PT for colorectal screening is recognized by Medicare and is reportable for professional and facility charges.

Regarding the deductible with the use of modifier -33 and facility charges for commercial payors, this would be based on the individual carrier.

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The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

Is Facility Fee Charge Waived for Medicare When Using Modifier -33: Q&A With Rosalind Richmond of GENASCIS

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